1. Introduction

Analysis of world literature indicates that the study of hernia repair remains one of the most popular branches of surgery. This is due to the frequency of occurrence of hernias, in particular inguinal hernias, which account for 70-80%. According to the World Health Organization (WHO), inguinal hernias affect about 3-6% of the population, among which this disease occurs in 6-7% of cases in males and in 2.5% of cases in females [2,11,15,16,17]. Inguinal hernia (IH) is one of the most common types of primary hernias of the anterior abdominal wall, which, according to statistics from countries with a high level of health care, is the reason for numerous surgical interventions [3,5,6,12,13,19]. Despite the large volume of research conducted to date, the problem of choosing a method of inguinal hernioplasty at the stage of preoperative preparation cannot be considered completely resolved, since clinical research methods do not allow obtaining the necessary information on the topographic and anatomical parameters of the inguinal canal.

The literature contains reports on the use of ultrasound examination (US) of the inguinal regions for the diagnosis of asymptomatic inguinal hernias [9,14], differential diagnosis of hernias with other diseases [18,20], as well as for verification of the deep inguinal ring in minimally invasive open surgical interventions and assessment of the degree of compression of the spermatic cord vessels in prosthetic hernioplasty in the postoperative period.

However, clear criteria allowing a differentiated approach to the choice of hernioplasty method based on the results of ultrasound morphometry of topographic and anatomical parameters have not been developed to date.

It should be noted that the literature does not specify the capabilities and significance of ultrasound, and no intravital comparative parallel studies of topographic and anatomical parameters have been conducted for different types of inguinal hernias in different age groups, which would increase the role and confirm the significance of this research method in inguinal hernia surgery.

The presence or absence of recurrence of an inguinal hernia has been one of the criteria for the effectiveness of surgical treatment for decades.

Currently, the presence of postoperative pain, both chronic and acute, has come to the forefront as a criterion of effectiveness. Chronic pain occurs as a result of local trauma to nerve fibers by penetrating and traumatic devices: staples, fixators, suture material [1,4,7,8,10]. Chronic postoperative pain is recorded, according to various data, in 3-12% of cases [1,3,11].

There are many studies comparing various options for surgical interventions, mesh endoprostheses, fixing devices; more advanced and modern ones are being invented.

Despite the widespread introduction of video endosurgical approaches to hernioplasty for inguinal hernias, there are a number of practical issues that sometimes cause doubts even among experienced surgeons: the choice of access, especially after previously undergone laparotomies, the volume of dissection of the preperitoneal space; the choice of the implant itself and its size for defects of different areas.

Thus, to improve the results of surgical treatment of inguinal hernias, it is necessary to use the optimal intervention technique for each patient and the method of positioning the mesh implant, taking into account the anatomical and technical prerequisites for the possible development of a recurrent hernia and chronic pain syndrome.

Objective of the study: Improving the treatment outcomes for patients with inguinal and scrotal hernias using a differentiated approach, taking into account the severity of the course and assessing the quality of life.

2. Materials and Methods

We analyzed the results of observations of 102 patients with inguinal and scrotal hernias for the period 2020-2024, who were treated in the Central Clinical Hospital of JSC Uzbekistan Railways and the Central Military Hospital.

All patients were examined according to a standard scheme, including clinical examination data from specialists and instrumental research methods: ECG; ultrasound; fluoroscopy; other studies as needed.

When examining the abdominal cavity and identifying other pathologies, magnetic resonance imaging (MRI) was used, if necessary, multispiral computed tomography (MSCT) with contrast and other necessary instrumental research methods.

In our studies, questionnaires were used to assess the quality of life: SF-36 test (36-item-Short Form health survey) and visual analogue scale (VAS) to determine the intensity of pain syndrome.

3. Results and Discussions

A total of 102 patients were studied during the study period; for convenience, they were divided into two groups according to the methods of surgical intervention. The control group - 54 patients who underwent the Lichtenstein operation in 2020-2022; the main group - 48 patients who underwent laparoscopic hernioplasty (LGP) in 2022-2024 using the optimized technique.

In the control group, 54 patients underwent Lichtenstein hernioplasty in a completely traditional way. In the main group, the TRR technique - hernioplasty was performed in 48 patients. Bilateral lesions were observed in 14 patients, and simultaneous surgery was performed in 17 cases.

The following complications were observed in the postoperative period: umbilical wound seroma - 2 (1%), inguinal hematoma - 4 (2%).

The average duration of hospitalization after LGP was 4.1±1.3 days. After the operation, patients returned to their normal lifestyle in 7-8 days.

After separation of the parietal peritoneum in the hernial area, damage to the intermuscular abdominal cavity was detected in 1 (0.5%) case, which required additional time to stop intermuscular bleeding. In 3 (1.5%) cases, elements of the seminal vesicle were separated together with the parietal peritoneum. In 1 (0.5%) case, nerve fibers were damaged when working with a hook at the stage of separation of space in the preperitoneal region. In 2 cases (1%), at the stage of separation of the hernial sac, damage to the inferior epigastric artery was observed.

In the postoperative period, postoperative seroma of the trocar wound was detected in 1 patient (1.9%), and hematoma of the inguinal region was detected in 1 patient (1.9%).

The average length of hospital stay after LGP was 5.1±1.2 days. After the operation, patients returned to their normal lifestyle within 8-9 days. One year after the operation, the patient did not have any remote relapses.

Analysis of clinical outcomes showed that the frequency of intraoperative and postoperative complications increased with increasing patient weight. While 6.0% of normal weight patients required trocar re-insertion, 38.1% of patients with a body mass index (BMI) of up to 35 kg/cm2 had a BMI of 35 to 41 kg/cm2, and 7% of patients with a BMI of 35 to 41 kg/cm2 had a BMI of 75 kg/cm2. Accordingly, the incidence of BMI and intraoperative complications increased accordingly. The complication rate in normal weight patients was 4.8%, and with a BMI greater than 35 kg/cm2, it increased to 33.3%. Due to technical difficulties and additional soft tissue trauma, the complication rate in normal weight patients with a BMI greater than 35 kg/cm2 increased from 1.2% to 33.3%. Accordingly, the number of postoperative complications increased.

A distinctive feature of the proposed method is the identification of reserve capabilities to reduce the frequency of postoperative complications in patients with high surgical risk. For a complete assessment of the therapeutic and aesthetic effect of the operations performed, an analysis was conducted to study the quality of life of patients. A special questionnaire "SF-36 Health Status Survey" was used. To compare the results, the parameters of the quality of life (QOL) of healthy individuals matched by gender and age were studied. In both groups, a reliable improvement in the quality of life of patients after surgery was noted. Thus, physical activity increased by 1.5-4 times. The same positive dynamics increased the psychological component of health by 1.5-3.5 times. Social and life safety was shown by 62% and 79% of those examined. When comparing the results of the QOL assessment with the study results, reliable good indicators were obtained in the main group. The minimum value in the main group was 70% on the pain intensity assessment scale, and in the comparison group - 48.1% on the mental health scale. The maximum value was 82% in the main group due to the role of physical activity in the general health condition, and in the control group - 67.3%. The total scores of the control component of physical health were 79.4% and 52.2% for the mental component, respectively, in the main group - 78.5% and 63.7% in the comparison group. Statistical processing of clinical material was carried out in Microsoft Office Excel - 2010 on a Pentium-IV 2.4 GHz computer, using the installed statistical processing function.

4. Conclusions

1. The observation analysis showed that the disease of patients occurs mainly at the working age of 18-59 years, about 93%, which makes the problem very relevant.

2. The implementation of the obtained conclusions and proposals in the practical activities of surgical clinics will allow diagnosing inguinal hernias, reducing postoperative complications and mortality in them, which will improve the quality of life of patients during the rehabilitation period.

3. The reliability of herniotomy in patients with inguinal hernias, performing simultaneous operations, which in turn will reduce intra-abdominal pressure, that is, the main link in the etiology of pathogenesis, will prevent relapse of the disease.

4. The developed effective treatment tactics depending on the level of the disease in the development of inguinal and inguinal-scrotal hernias in military personnel will improve the results of surgical treatment.

5. The data of the conducted study will help in developing a rational algorithm of surgical methods of treatment and prevention based on the identification of risk factors and improvement of measures to eliminate them, which will improve the treatment results of patients with inguinal and inguinoscrotal hernias in military personnel.

6. A study of 102 patients showed that the parameters of the SF-36 QOL test suffer as the disease progresses with inguinoscrotal hernias and improve after recovery.

7. The visual analogue scale and its five parameters allow a more detailed study of the pain syndrome, no pain (0 points), mild pain (1-3 points), moderate pain (4-6 points), very severe pain (7-9 points), unbearable pain (10 points), which means the maximum possible version of the sensation of pain syndrome will allow determining the pain syndrome throughout the disease in chronic cases persists.